I took a deep breath, closed my eyes and exhaled.
I did it again. And again. Then one more time.
I had just finished the last chapter of Being Mortal, Atul Gawande’s powerful discussion of medicine and dying. Throughout the last half of the book, as he dissects the problems that plague end-of-life care in the United States, Gawande weaves in the deeply personal story of his father’s struggle with incurable brain cancer.
“We went to him. My mother took his hand. And we listened, each of us silent. No more breaths to come,” Gawande writes on the closing page.
Reading that last line, my head filled with memories of being at my father’s bedside in the ICU as he took his last breath. Images of seeing my mother-in-law and father-in-law succumb to their illnesses, roughly a year apart from each other, flooded my brain, too.
Flying 30,000 feet above the ground, on my way to a conference where Gawande was a featured speaker, all I could do was close my eyes, breathe and let the memories fade.
For anyone who has struggled to navigate the many complexities of end-of-life care with a loved one, Gawande’s book is a vivid reminder not only of human frailty and the dysfunction that exists in the delivery system, but also of the positive change that comes from the power of purpose. Gawande’s own transformation from a physician who simply lays out facts and options to one who connects with patients about their wishes and desires is impactful.
“We’ve been wrong about what our job is in medicine,” Gawande writes in the epilogue. “We think our job is to ensure health and survival. But really, it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive.”
Gawande further discussed his awakening to this idea during a speech at last month’s Health Forum–American Hospital Association Leadership Summit. More broadly, though, he asked attendees to reimagine how care is designed and delivered. The challenge is one that we’ve been struggling with for ages — better coordination across the system and more responsiveness to patient needs. Innovation, he said, doesn’t necessarily have to be disruptive; rather we should seek out ideas that knit the system together.
“The hardest things to get to spread in our system are discoveries that are painful or difficult for teams to execute on,” Gawande told me during an interview following his speech [http://bit.ly/1D8K4lF]. “Ones that are really good for the patient and good for the doctors move incredibly fast.”
Think anesthesia — pain-free surgery, plus no more screaming patients on the table. Or Viagra, which was good for patients and brought more visits to urologists. Contrast that with treating a patient with a chronic illness, he said. Ensuring that patients go to follow-up visits, orchestrating communication and coordination among different clinicians, and connecting to the patient at home is “hard” and “painful” to do, but have extraordinary benefits upstream.
“Being able to deliver on those capabilities and make it easier and easier for teams to do this work, that’s going to be where huge value comes from for the patient and, ultimately, for the teams.” — You can reach me at firstname.lastname@example.org.